Active NPI
Village of Riverside
Doing business as Riverside Fire Department
- Land Ambulance
- Riverside, IL
National Provider Identifier
1568405744
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Land Ambulance
- License
- 8078
- Legal business name
- VILLAGE OF RIVERSIDE
- Doing business as
- Riverside Fire Department
- Practice address
- 27 Riverside Rd
Riverside, IL 60546-2278 - Phone
- (708) 447-2123
- Fax
- (708) 442-4382
- NPI assigned
- Jun 14, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Karin S Johns
- Title
- Finance Director
- Phone
- (708) 447-2700
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | 8078 | IL | Primary |
Addresses
Primary practice location
27 Riverside Rd
Riverside, IL 60546-2278
Mailing address
1 Pierce PL Ste 750W
Itasca, IL 60143-1234
Phone (847) 678-0865
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 590008278 | Other | IL | RR MEDICARE |
| 1619798 | Other | IL | BCBS |
Other names 1
- Riverside Fire Department
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080911000460 | IL | Part B Supplier - Ambulance Service Supplier | 1658447883 | Practice locations: Riverside, IL |
National Provider Directory
National Provider DirectoryLocations
27 Riverside Rd
Riverside, IL 60546
Phone (708) 447-2123
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150243200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1691625600000",
"number": "1568405744",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 PIERCE PL STE 750W",
"city": "ITASCA",
"state": "IL",
"postal_code": "601431234",
"telephone_number": "847-678-0865",
"fax_number": "847-678-0865"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "27 RIVERSIDE RD",
"city": "RIVERSIDE",
"state": "IL",
"postal_code": "605462278",
"telephone_number": "708-447-2123",
"fax_number": "708-442-4382"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "VILLAGE OF RIVERSIDE",
"organizational_subpart": "NO",
"enumeration_date": "2006-06-14",
"last_updated": "2023-08-10",
"certification_date": "2023-08-10",
"status": "A",
"authorized_official_last_name": "JOHNS",
"authorized_official_first_name": "KARIN",
"authorized_official_middle_name": "S",
"authorized_official_title_or_position": "FINANCE DIRECTOR",
"authorized_official_telephone_number": "708-447-2700"
},
"taxonomies": [
{
"code": "3416L0300X",
"taxonomy_group": "",
"desc": "Ambulance, Land Transport",
"state": "IL",
"license": "8078",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "590008278",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "1619798",
"state": "IL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Riverside Fire Department",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Riverside Fire Department",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Riverside, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.